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Biomedical subjects

S Y Chu

Publications and source records attributed to S Y Chu.

At least 37 records · Page 2Linked to original sources
PubMed1996

Race/ethnicity misclassification of persons reported with AIDS. The AIDS Mortality Project Group and The Supplement to HIV/AIDS Surveillance Project Group.

OBJECTIVES: To examine differences in race/ethnicity classifications of persons with AIDS among three reporting sources and to estimate the effect of these differences on calculated AIDS rates. METHODS: We reviewed case reports from the national AIDS surveillance database, interview (self-reported) data from 11 state/local health departments, and death certificate information from 16 state/local health departments for agreement in race/ethnicity coding among persons reported with AIDS. RESULTS: Race/ethnicity coding inconsistencies with AIDS case reports were greatest for persons identified as American Indians/Alaska natives on death certificates (46% [47/102] disagreement) and by self-report (57% 8/14 disagreement). Agreement with AIDS case reports was highest either for persons identified as white from death certificates (4% [1314/31,070] disagreement) and white from self-reports (2% [26/1068] disagreement) or black from death certificates (3% [440/13,592] disagreement) and black from self-reports (3% [21/736] disagreement). For other racial/ethnic groups, disagreement with AIDS case reports was intermediate; for Asians/Pacific Islanders, 12% [45/377] disagreement with death certificates and 33% 4/12 disagreement with self-reports; and for Hispanics, 14% [1151/8527] disagreement with death certificates and 24% [59/249] disagreement with self-reports. CONCLUSION: For certain racial/ethnic groups, classification by race/ethnicity can differ substantially by surveillance data source. Because allocation of public health resources may be determined by estimates of disease impact on different population groups, periodic evaluations of the accuracy of race and ethnicity reporting are needed to assure appropriate distribution of these resources.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Toxoplasmic encephalitis in HIV-infected persons: risk factors and trends. The Adult/Adolescent Spectrum of Disease Group.

OBJECTIVE: To evaluate the incidence of and risk factors for toxoplasmic encephalitis among HIV-infected persons. DESIGN: Medical facility-based prospective medical record reviews of consecutive patients. METHODS: We analysed data collected from January 1990 through August 1995 in more than 90 inpatient and outpatient medical facilities in nine US cities. Incidence was calculated as cases per 100 person-years and risk ratios (RR) for annual incidence were calculated using proportional hazards regression while controlling for city, sex, race, age, county of birth, HIV exposure mode, and prior prescription of trimethoprim-sulfamethoxazole (TMP-SMX). RESULTS: The incidence of TE was 4.0 cases per 100 person-years among persons with a CD4+ T-lymphocyte count of < 100 x 10(6)/l. In multivariate analysis, among the nine cities the annual incidence of toxoplasmosis was significantly lower only in Denver [RR, 0.3; 95% confidence interval (CI), 0.1-0.7; referent city, Seattle]. Persons prescribed TMP-SMX were half as likely to develop toxoplasmic encephalitis as those who were not (RR, 0.5; 95% CI, 0.4-0.7). Of the 4173 persons with AIDS (1987 Centers for Disease Control and Prevention definition) who died during the study period, 267 (6.4%) had toxoplasmic encephalitis in the course of HIV disease. CONCLUSIONS: Toxoplasmic encephalitis in HIV-infected persons varies by geographic area in the United States. TMP-SMX reduces the risk for toxoplasmic encephalitis.

AIDS-Related Opportunistic Infections↗
PubMed1996

Characteristics of women 50 years of age or older with heterosexually acquired AIDS.

OBJECTIVES: This study compared characteristics of older (> or = 50 years) and younger (< 50 years) women with acquired immunodeficiency syndrome (AIDS) attributed to heterosexual contact. METHODS: We interviewed women with heterosexually acquired AIDS reported to 12 state and local health departments. Of 556 women interviewed, 59 (11%) were 50 or older. RESULTS: Older women were more likely than younger women to live alone (24% vs 11%), to have not completed high school (63% vs 37%), to be tested for human immunodeficiency virus (HIV) while hospitalized (51% vs 32%), and to have never used a condom before HIV diagnosis (86% vs 67%). CONCLUSIONS: Health care providers need to recognize HIV risk behavior in older women, encourage testing, and promote condom use.

Acquired Immunodeficiency Syndrome↗
PubMed1996

The supplement to HIV-AIDS Surveillance project: an approach for monitoring HIV risk behaviors.

A variety of surveillance methods are used to characterize the epidemic of HIV infection and AIDS. Such surveillance includes AIDS case reporting, reporting of diagnosed HIV infections, and HIV seroprevalence surveys among targeted sentinel populations. The need for additional surveillance systems to monitor HIV-related risk behaviors has been increasingly evident. One approach to behavioral surveillance, the CDC's Supplement to HIV-AIDS Surveillance project, uses the infrastructure of HIV infection and AIDS case reporting to collect additional information on risk behaviors among HIV-infected persons, who by definition represent those at highest risk.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Trends in infectious diseases and cancers among persons dying of HIV infection in the United States from 1987 to 1992.

OBJECTIVE: To determine trends in the relative frequency of infectious diseases and cancers among U.S. residents dying of human immunodeficiency virus (HIV) infection. DATA SOURCE: National multiple-cause mortality data for 1987 to 1992 compiled from death certificates. SUBJECTS: Deaths reported with HIV infection as the underlying cause and with nonunderlying causes that could be secondary to HIV infection. DATA ANALYSIS: Trends in the annual percentage of deaths associated with each infectious disease or cancer that accounted for at least 1.0% of all HIV-related deaths. RESULTS: From 1987 to 1992, the percentage of HIV-related deaths associated with the following diseases decreased: pneumocystosis, from 32.5% to 13.8%; cryptococcosis, from 7.7% to 5.0%; and candidiasis, from 2.3% to 1.7%. The percentage of deaths associated with the following diseases increased: nontuberculous mycobacteriosis, from 6.7% to 12.2%; cytomegalovirus disease, from 5.2% to 9.9%; bacterial septicemia, from 9.0% to 11.5%; non-Hodgkin lymphoma, from 3.9% to 5.7%; tuberculosis, from 2.9% to 4.1%; progressive multifocal leukoencephalopathy, from 0.8% to 1.9%; bacterial pneumonia, from 1.2% to 2.1%; and cryptosporidiosis or isosporiasis, from 0.7% to 1.2%. The percentages of deaths associated with toxoplasmosis, Kaposi sarcoma, and pneumonia caused by unspecified organisms had no significant linear trends (ranges from 4.9% to 5.5%, 10.4% to 12.1%, and 17.6% to 18.6%, respectively). CONCLUSIONS: The percentage of HIV-related deaths associated with pneumocystosis has decreased dramatically, probably because of chemoprophylaxis and improved treatment. Pneumonia caused by unspecified organisms has now become the leading secondary cause of death among persons dying of HIV infection. Decreases in the percentages of HIV-related deaths associated with cryptococcosis and candidiasis may reflect the use of new antifungal agents such as fluconazole.

AIDS-Related Opportunistic Infections↗
PubMed1995

Differences in participation in experimental drug trials among persons with AIDS.

To measure participation in experimental drug trials among persons with acquired immunodeficiency syndrome (AIDS), we interviewed 4,604 persons at least 18 years of age who were reported to have AIDS to 11 state and city health departments in the United States. Ten percent reported that they were currently in a trial. Current enrollment differed significantly (p < 0.05) by race/ethnicity (blacks, 5%; whites, 14%; Hispanics, 15%), gender (women, 7%; men, 11%), exposure mode (injection drug use, 5%, men who have sex with men, 14%), annual household income (< $10,000, 8%, > or = $10,000, 14%), education (< 12 years, 6%; > or = 12 years, 12%), health care (no regular care, 1%, public care, 8%; private care, 17%), and time since AIDS diagnosis (< or = 6 months, 9%; > 6 months, 12%). Adjusting for all factors and time since AIDS diagnosis, blacks (adjusted odds ratio [AOR] = 0.35, 95% confidence interval [CI] 0.26, 0.47), persons with less than 12 years of education (AOR = 0.71, CI 0.53, 0.96), and those without regular health care (AOR = 0.24, CI 0.10, 0.61) remained less likely to be in a trial. Blacks, those with less than 12 years of education, and persons without regular health care were less likely than other persons with AIDS to be currently enrolled in AIDS trials. To increase enrollment of these persons, researchers must address barriers to participation for these groups.

Acquired Immunodeficiency Syndrome↗
PubMed1995

How important is race/ethnicity as an indicator of risk for specific AIDS-defining conditions?

In order to examine differences in the prevalence of AIDS-defining conditions by race/ethnicity, we analyzed U.S. surveillance data for 203,470 adolescents and adults diagnosed with AIDS from 1988 through 1992. A number of AIDS-indicator conditions were more common among certain racial/ethnic groups. The prevalence of extrapulmonary tuberculosis was higher among blacks, Hispanics, Asians/Pacific Islanders, and American Indians/Alaskan Natives than among whites. The prevalence of isosporiasis and toxoplasmosis was higher among Hispanics than among blacks or whites. Furthermore, the likelihood of being diagnosed with extrapulmonary tuberculosis (TB), toxoplasmosis, or isosporiasis was generally higher among foreign-born than among U.S.-born persons of all racial/ethnic groups. The prevalence of all malignancies was higher among whites than among blacks or Hispanics. However, the magnitude of prevalence differences by race/ethnicity was reduced when we controlled for other demographic and exposure risk categories. Although race/ethnicity was significantly associated with the prevalence of a number of conditions, the relative frequency and patterns of AIDS-indicator conditions in different populations are probably most influenced by differences in (1) underlying prevalence or exposure to various etiologic agents causing these conditions, (2) diagnosis and reporting of conditions, and (3) access to care and therapy for HIV-related conditions.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Distribution of CD4+ T lymphocytes at diagnosis of acquired immunodeficiency syndrome-defining and other human immunodeficiency virus-related illnesses. The Adult and Adolescent Spectrum of HIV Disease Project Group.

BACKGROUND: Depletion of circulating CD4+ T lymphocytes among persons infected with the human immunodeficiency virus (HIV) is associated with increased risk for development of opportunistic, life-threatening diseases and death. METHODS: To describe the levels of CD4+ T lymphocytes at which acquired immunodeficiency syndrome (AIDS)-defining and other illnesses initially occur, we analyzed data from an ongoing survey of medical records of 18,062 HIV-infected patients who received medical care between January 1990 and August 1993 in more than 100 clinics, hospitals, and private practices in 10 US cities. We report the median and upper 80th percentile CD4+ T-lymphocyte counts at diagnosis. RESULTS: We found that AIDS-defining conditions first occurred in HIV-infected patients with CD4+ T-lymphocyte counts below 0.20 x 10(9)/L (200/microL) for 80% of diagnoses. Similarly, AIDS-defining diseases occurred at counts below 0.05 x 10(9)/L for 50% of diagnoses. Exceptions to both criteria were invasive cervical cancer and pulmonary tuberculosis. Non-AIDS-defining illnesses with which 80% of patients were diagnosed at CD4+ T-lymphocyte counts below 0.20 x 10(9)/L were bacterial sepsis and retinopathy (excluding cytomegalovirus). CONCLUSION: Our observations support the need for continued CD4+ cell count monitoring below a level of 0.20 x 10(9)/L as a guide to diagnosis and medical management of HIV-infected persons.

AIDS-Related Opportunistic Infections↗
PubMed1995

Relationship between use of condoms and other forms of contraception among human immunodeficiency virus-infected women. Supplement to HIV and AIDS Surveillance Project Group.

OBJECTIVE: To describe the relationship between condom use and use of other contraceptives among human immunodeficiency virus (HIV)-infected women. METHODS: We interviewed 1232 women, 18-50 years of age, who had had sex with a man in the prior 12 months and who were reported with AIDS or HIV to local health departments in 12 states and cities in the United States. These women were asked about condom use and other contraceptive use in the past year. RESULTS: Forty-seven percent of women reported using condoms as a form of contraception in the past 12 months. Thirty-four percent of the 286 women who had had a tubal ligation and 42% of the 182 women who used oral contraceptives (OC) used condoms. When we controlled for all factors associated with failing to use condoms, women who had had a tubal ligation (adjusted odds ratio [OR] 1.72, 95% confidence interval [CI] 1.28-2.33), women who used OCs (adjusted OR 1.44, CI 1.00-2.08), and women who were unaware of the HIV status of their most recent steady sex partner (adjusted OR 1.72, CI 1.28-2.31) were the least likely to use condoms. CONCLUSION: Human immunodeficiency virus-infected women who used more effective contraceptive methods were the least likely to have male sex partners who used condoms. In counseling women at high risk of transmitting HIV, health care providers should discuss reasons for using contraceptives (ie, preventing pregnancy versus preventing HIV transmission) and ensure that women understand that different forms of contraceptives may be needed to achieve those different purposes.

Acquired Immunodeficiency Syndrome↗
PubMed1995

The migration of persons with AIDS: data from 12 states, 1985 to 1992. AIDS Mortality Project Group.

This study measured the migration of persons with the acquired immunodeficiency virus (AIDS) between diagnosis and death using AIDS case and death reports from 12 states for 1985 to 1992. Of 49,805 persons with AIDS, 10.6% changed their place of residence, and half of these individuals who moved changed their state of residence. Migration had relatively little impact on the numbers of persons with AIDS in the largest metropolitan areas, which accounted for approximately 90% of AIDS diagnoses. Although only 3% of deaths occurred in residents of nonmetropolitan areas, the net effect of migration was a 24% increase in the number of persons with AIDS residing in such areas.

Acquired Immunodeficiency Syndrome↗
PubMed1995

The effect of mild or moderate hepatic impairment (cirrhosis) on the pharmacokinetics of zileuton.

The pharmacokinetics of zileuton and its R(+) and S(-) glucuronide metabolites were determined after single and multiple (400mg every 8 hours) oral dose administration in healthy subjects (n = 5) and patients with mild or moderate hepatic impairment (cirrhosis; n = 8). The clearance of total zileuton (unbound plus bound to plasma proteins) in patients with hepatic impairment (approximately 350 ml/min) was approximately half than in healthy subjects (approximately 670 ml/min), with similar values in patients with mild or moderate cirrhosis. However, the clearance of unbound zileuton in patients with moderate hepatic impairment was nearly half that in patients with mild hepatic impairment, and one quarter that in healthy subjects. On the basis of these findings, it may be necessary to reduce the dose in patients with impaired hepatic function to maintain levels similar to those in healthy subjects.

Administration, Oral↗
PubMed1995

Methodological and statistical considerations for exercise-related hormone evaluations.

Improvements in laboratory techniques have allowed research related to exercise endocrinology to flourish. The emerging literature, however, is often inconsistent and contradictory. The discrepancies in research findings are possibly the result of poor control of confounding variables and/or inappropriate methodologies or analyses. Environmental and pretesting behavioural conditions must be standardised to minimise the influence of variables not directly related to the investigation. Environmental temperature and relative humidity, alcohol, caffeine and nicotine intake, prandial state, sleep deprivation and previous exercise can each alter hormonal responses to exercise. Both prescription and over-the-counter medications can also modify normal hormonal secretions thereby confusing exercise-induced findings. Specimen collection and analysis procedures must be controlled carefully. Changes in plasma volume related to postural changes or tourniquet-induced stasis can confound attempts to isolate exercise-related endocrine responses. The established circadian and rhythmical variations characteristic of many hormones need to be controlled. The specimen selection (plasma, serum, urine, etc), collection, storage and analysis procedures should be carefully planned and evaluated. The magnitude of haemolysis, analytical and biological variation must also be monitored. Isolating the hormonal perturbations resulting from a particular exercise variable can be very difficult. Exercise intensity, duration, mode, frequency and volume may each have specific effects on the endocrine changes seen with exercise and training. Furthermore, hormonal responses to exercise are dependent upon initial training status and fitness level. The statistical procedures and data presentation options selected to convey experimental findings can bias experimental results. The descriptive and inferential statistics to be used for data analysis should be preplanned and consistent with the underlying assumptions of the analytical procedure. Careful consideration should be given to the biological relevance of statistically significant findings. In some cases, data transformations (e.g. absolute vs relative changes, logarithmic) should be considered for analysis or presentation. Given the individual nature of hormonal responses to exercise, emphasis should be placed presenting individual data. Other considerations, including age, sex, racial origin and disease conditions need to be controlled for when trying to examine exercise-induced hormone changes.

Behavior↗
PubMed1995

HIV testing patterns: where, why, and when were persons with AIDS tested for HIV?

OBJECTIVE: To describe the location of, primary reason for, and time between the first positive HIV test and AIDS diagnosis in a sample of persons with newly diagnosed AIDS. DESIGN: Interviews supplementing information routinely collected through AIDS case reporting. SETTING: Eleven US states and cities. PATIENTS: Persons with AIDS (2441) diagnosed between January 1990 and December 1992. MAIN OUTCOME MEASURES: Location of first positive HIV test, primary reason for testing, and time interval between first positive HIV test and AIDS diagnosis. RESULTS: Overall, persons were tested late in their course of HIV infection: 36% were tested for HIV within 2 months and 51% within 1 year of their AIDS diagnosis. Sixty-five per cent were HIV-tested in acute health-care settings: 33% in hospitals, 28% in physicians' offices, and 4% in emergency departments. Testing during hospitalization was most common among injecting drug users (43%) and persons infected through heterosexual contact (50%). Persons primarily sought HIV testing because of illness (58%); other reasons included being in a known risk group (13%) and having had a known HIV-infected sex partner (8%). Testing because of being in a known risk group was least common among persons infected through heterosexual contact (1%). Among persons in these exposure categories, testing differed by race/ethnicity. CONCLUSION: Most persons with AIDS were tested relatively late in their course of HIV infection, in acute health-care settings, and because of illness. Not knowing one's serostatus precludes early medical intervention and may increase transmission.

AIDS Serodiagnosis↗
PubMed1995

Who are the primary caretakers of children born to HIV-infected mothers? Results from a multistate surveillance project.

OBJECTIVE: To determine the primary caretakers of children born to women with human immunodeficiency virus (HIV) infection. METHODS: We interviewed women at least 18 years of age who have been reported with HIV infection or acquired immunodeficiency syndrome to local health departments in 10 cities and states regarding the primary caretaker of their children born since 1977. RESULTS: Of 541 HIV-infected women who had been pregnant since 1977, 88% had living children. These women comprised 478 family units (mother and children); 234 (49%) of these units consisted of two or more children. The most common primary caretakers for all children within a family unit were the mother alone (46%), grandparents (16%), and both mother and father (15%). When the mother used injection drugs or lived alone, in a shelter, or with friends, almost one quarter of all children were cared for by their grandparents. Only 30% of the mothers knew about child care assistance services, and only 8% had contacted or used these services. CONCLUSIONS: Mothers with HIV, often alone, are the primary caretakers of their children. Increased provisions for child care assistance and planning for future permanent placement of orphaned children are urgently needed.

Adult↗
PubMed1994

Sensitive method for the assay of sertindole in plasma by high-performance liquid chromatography and fluorimetric detection.

A simple and highly sensitive normal-phase HPLC method is described for determining sertindole concentrations in human plasma using fluorimetric detection. A short C8 column was used to extract sertindole and the internal standard from plasma; the column was rinsed with acetonitrile, and the analytes were recovered by elution with methanol. This uncommon selectivity between the two solvents allowed clean extraction and near- quantitative recovery of the analytes (> 89%). Separation was done on a 5-microns silica-gel column and detection was performed by fluorimetry, with emission at 340 nm and excitation at 260 nm. The detection and lower quantifiable limits were 0.01 and 0.025 ng/ml, respectively, with no interference from plasma or potential metabolites.

Antipsychotic Agents↗